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Early Days Of Harm Reduction in Liverpool

In the mid 1980s, the Mersey Health Region, which consisted of the counties of Merseyside and Cheshire in the UK, became the focus of attention because of its radical and pioneering approach to dealing with the problems connected with drug use. Most of this focused on Liverpool, the biggest city in the region. Liverpool has a proud history of public health and was the first city in the world to appoint a Medical Officer of Health in 1847.

At that time it was identified as the unhealthiest town in Britain. In the early to middle 1980s, John Ashton of the University of Liverpool, Department of Public Health, and later Mersey Regional Director of Public Health and Howard Seymour, Head of the Health Promotion of the Mersey Regional Health Authority (MRHA), had been developing the ideas of the New Model for Public Health. This brought together the old ideas of environmental change, prevention and therapeutic interventions. But they went further and recognised the importance of those social aspects of health problems, which are caused by lifestyles. In this way it seeks to avoid the trap of victim blaming.

They were interested in applying it to a then emerging public health problem, drugs and AIDS. Liverpool, actively promoting a shift towards the promotion of healthier lifestyles through its prominent involvement in the World Health Organisation’s ‘Healthy Cities’ project, was one of the first two British cities to participate in the project launched in 1996. Under he leadership of John Ashton, a number of effective community-based projects aimed at creating healthier lifestyles were created.

In the mid-1980s, an influx of cheap brown heroin gave Liverpool another bad reputation as “smack city”. Other parts of the Mersey Region, including the areas of the Wirral and Bootle had similar high levels of heroin use. It was estimated that there were about 5000 heroin users in the Wirral out of a total population of about 300,000, and that there were about 20,000 drug users in the region in a population of about two and a quarter million people. Services were much as they were in the rest of the UK, with detoxification being the prevalent treatment. According to one drug worker at one Drug Dependency Unit, one person was detoxified 14 times in 12 months.

In 1985, Ashton and Seymour attended the World Health Education Conference in Dublin and met Glen Margo from San Francisco who was working on AIDS prevention. He made such an impression on them that they invited him to Liverpool to give a series of lectures to sensitise decision makers and potential activists across the community to the issue of AIDS and to present a model for organising prevention programmes.

Extensive media coverage raised awareness in the general public of an issue that had not been taken seriously in the UK. A subsequent visit to the USA revealed a difference in approach between New York and San Francisco, the latter being a classic public health approach involving political organisation, market research of groups at risk, creative use of mass media, activism, the involvement of the risk groups in programmes and community support. At the same time other key individuals—including the late Sir Donald Wilson, Chairman of the Mersey Regional Health Authority, John Marks, a psychiatrist in the region and Allan Parry, a health promotion worker found themselves in the right place at the right time. Parry was responsible for the implementation of the strategy and played a crucial role in its development. All of these factors facilitated the implementation of a harm reduction approach to drug use in the region, especially the threat of HIV through the sharing of infected injecting equipment.

This was based on public health principles that influenced the later historic recommendations of the UK’s Advisory Council on the Misuse of Drugs (ACMD) 1988 report. Services were created from 1985 involving the consumer, which gave drug users the information and the means to protect themselves, especially those drug injectors most at risk. The Mersey Harm Reduction Model was taking shape.

The Know Series

The drug scene is constantly changing and new drugs are being used alongside the old favourites. There has been an increase in drug-related deaths and problems using ‘new’ drugs. Too many users are being put at risk by not knowing what they are taking, taking too much and/or mixing drugs.

Here at HIT we aim to inform, educate and promote safety amongst drug users.

We are concerned that not enough drug information is getting out there. A lot of information on the internet is patchy, inaccurate and/or gives little information about how to keep safe. Fewer organisations are producing drug leaflets and public sector cutbacks mean many agencies cannot purchase as many drug information resources for their clients as they once did.

In response we have produced:

These five new colourful, reasonably priced leaflets are easy to read and bang up to date. They will help keep actual and potential users as safe as possible and are also informative for professionals and the public at large.

Each leaflet covers: what the drug is, the law, effects of using, possible harms, how to stay safe and where to find out more.

You can either buy these new leaflets individually or  save money by buying them as a full set.

Inform, educate and promote safety.

Shop for this series

Basic Presenter Tips

Presenting at a conference or seminar, either one of our Hot Topics events or elsewhere, then you might find some of our simple presenter tips useful. We’ve broken them down into sections for slides, venue and presenting.


In all likelihood you’re going to use a presentation tool, you might be doing things differently and using a tool like Prezi or Haikudeck or just sticking with the usual Powerpoint, the same simple tips are the same for all platforms.

  • A Picture is worth 100 words. People are not coming to your presentation to read a book, don’t fill the screen with a sea of text when a simple photo image will say so much more, people are coming to see you speak not to watch you read. There are many good sites online for grabbing images.
  • Only have slides you’ll use We’ve all seen people skipping madly though slides they’re not using that day, don’t be that guy. If you think you won’t use a slide then don’t include it. It’s also worth making sure that each slide that you do use is one that you can talk about for either 30 seconds or 5 minutes, that way when you’re nearing the end of your talk you can lengthen or shorten it seamlessly depending on the remaining time you have.
  • Pick a transition/animation and stick to it. Powerpoint has lots of transition styles, you do NOT need to use them all. Unless the animation your using is there to explain a point (eg moving aspects of a venn diagram together) then keep it simple and subtle, personally I always just use ‘fade’ to bring items in or out.
  • Use naked data. If you’re representing data take a good look at the chart you’re using, is it just lifted from the research and dumped onto a presentation screen? Take a look at it using a projector and sitting 50 feet away, the chances are it becomes meaningless. In reality that complex chart is there for you to refer to a single point of data. There are many ways to represent data in a clear visual way, a first step is just removing parts of a chart that don’t matter (for a perfect example read this article by Dark Horse Analytics).
  • Learn to use presenter mode. If you’re a powerpoint user learn to use it’s presenter mode, this means while the audience sees your slides you get to see your slides, notes, next slide and a timer. Of course you also need to check that the venue will be set up to use this.
  • Practice, practice, practice. Get some friends to listen to you speak, it’ll give you some idea of your timings and where things need polishing. This is also a good time to check that the presentation works in the way it should.
  • Have multiple copies. If possible send a copy of your presentation to the venue ahead of time, but also have a copy with you on a flash drive (ok I’ll go further, I have copies saved in multiple versions for Powerpoint so if the venue has old tech I’m covered, I also save in multiple screen resolutions. I have 2 flash drives I keep with me AND I have copies saved to online services like Dropbox just in case everything else fails.)


  • Get there early. Get to the venue in plenty of time to have a look around, sit in some of the seats so you know how things will look for the audience, and of course check that there are no problems with the presentation (especially when using presentations that have the need for online connectivity).
  • Check who’s in charge. Is the session you’re speaking in ‘chaired’ if so meet the chair, talk about how you want to be introduced and check who will keep you to time.
  • Empty your pockets. Find somewhere to keep any bags you have, empty your pockets and make sure you haven’t had a clothing fail. Unless you’re using props of some kind the last thing you need is extra ‘stuff’ on the stage.


  • Don’t just stand there. Unless you are told you have to stand still please don’t (if there is a microphone to use ask if they have a mobile one). Moving around makes you seem more like you’re engaging with an audience than ‘lecturing’. It also has the advantage of giving you extra time to think (walking from one side of a stage to the other without talking doesn’t seem strange, but standing at a lectern silently for the same amount of time sees eternal).
  • Speak to the audience. Pick a few friendly faces around the group you’re talking to and present to them, don’t talk to your screen.
  • You’re the expert. Although personally I hate the term ‘expert’, if you’ve been asked to speak at an event the audience will consider you one, they’ve come to see you speak because you know your topic, the presentation is just there as a tool to help you say what you’re saying. You are the presentation.
  • Calls to action. A good presentation not only give people information but encourages people to act on that information, be sure to tell people what they can do to continue the work, or at the very least help you continue it.
Of course these are not ‘rules’ but just a working guide. one of the best ways you can improve your presentation skills is to watch people who really are the ‘experts’, go and watch a selection of TED talks and see how others really engage the audience.

Naloxone And The Rising Cost of Saving a Life

Dan Bigg is the Director of the Chicago Recovery Alliance who have been giving out naloxone since the mid 1990s, in this short film he talks about the impact a rising cost of the drug is having on the number of people whose lives can be saved.

In this film Dan mentions the differing costs of the different forms and formulations of naloxone, including the Enzio Auto-Injector which currently costs over $750.

What are your opinions on the rising costs of this (and other) life saving medications. Is it just a case of needing more equipment suppliers to drive down the costs, via competition or is there some other way to ensure lives can continue to be saved?

Presenter Guidelines

These guidelines are written for anyone presenting at a HIT Conference or seminar event. If you are presenting or running an event elsewhere you may well still find them useful. Please read though the information carefully to ensure that on the day everything runs smoothly.

Getting to The Venue And Timings

Venue details will be available on the conference/seminar page of our website, we will also contact you separately via email with full details of the venue and the planned time of your session. This email will include how long your session is intended to run (including if you are to leave time for questions, breaks in seminars etc). Please be sure to arrive early to make sure we have everything ready for you.

Your Presentation Slides (Powerpoint)

If possible we need to have your powerpoint slides before the conference/seminar starts, this way we can have it preloaded on the system. If there are last minute changes to your talk, please get these to us as early as possible on the day (find any of our HIT staff, there is usually someone managing our promotional stand).

Remember that your presentation will likely be running on a different computer from the one it was written on. This will mean that things like fonts you’ve used and videos will need to be ’embedded’ in the file if you want to be 100% sure the slides work as you formatted them.

We also recommend bringing a copy of your presentation with you on a flash drive (Our Community Manager would say “two flash drives, saved to your email account, in a folder on dropbox etc etc… but he panics about his slides not working).

Presentation Slides (If Not Using Powerpoint)

It may be that you want to use another system for your presentation:

  • Prezi: Prezi users please export your Prezi to a file and send us this. Also please send us the link to the online version of the Prezi ahead of the conference. Remember that video embedded in a Prezi requires an active internet connection, while we do try and make sure the venue has full internet access we cannot guarantee how fast the connection will be
  • Haiku Deck: Please send us the link to the web version of your deck. If you are running the deck from a mobile device like an iPad please let us know in advance so we can check that we have the right cables for connecting to the projection system.
  • Keynote: Please export your keynote as a Powerpoint file and send us this file. If you are planning to bring your own macbook or iPad to deliver from, please let us know in advance so we can check that we have the right cables for connecting to the projection system, if you have your own cables to connect to a projector system bring them as well, just in case. (If possible still also export a version as a Powerpoint file just in case as a backup option.)

After the conference

We keep an archive of our conferences and seminars on the website including the slides and where possible videos filmed on the day. If for any reason you do not want part of your presentation including in this, (eg if there are pictures that contain sensitive information) please let us know as soon as possible.

All slides are put online in a converted format that maintains as far as possible the look of the slides on the day they’re presented (we do NOT post a copy of your Powerpoint file online). Presentations made with services like Prezi or Haiku Deck will be converted to a format we can use, in this case transitions and animations may be lost.

If you want your ‘Notes’ field to be viewable by site visitors to give people ‘context’ and explanation of the slides, please put any text in the ‘Notes’ area (you can do this after the event, or send us 2 versions – one for the conference, one for the web).

Will The New NSP Guidance Change Services For People Who Use Steroids?

NICE have released their latest guidance for Needle and Syringe Programmes, in this latest version they have included strong guidance for the delivery of services to people who use Performance and Image Enhancing Drugs (PIEDs).

Including that services:

  • Are provided at times and in places that meet the needs of people who inject image and performance-enhancing drugs. (For example, offer services outside normal working hours, or provide outreach or detached services in gyms.)
  • Provide the equipment, information and advice needed to support these users
  • Are provided by trained staff
  • advice on alternatives (for example, nutrition and physical training can be used as an alternative to anabolic steroids)
  • information about, and referral to, sexual and mental health services

View full guidance

So, do YOU think this guidance is going to change the way services are delivered to PIED users? Will commissioners take notice?